OBJECTIVES To demonstrate a rare but potential mechanism of quadriplegia in a patient with fulminant pneumococcal meningitis complicated by severe intracranial hypertension. DESIGN Case report. SETTING Intensive care unit. PATIENT A 21-year-old man who presented with 3 days of headache, combativeness, and fever. INTERVENTION Antibiotics and steroids were initiated after lumbar puncture ...

The Middle East respiratory syndrome corona virus (MERS-CoV) is a novel positive sense singlestranded ribonucleic acid virus of the genus Beta corona virus. This virus was first isolated from a patient who died from severe respiratory illness in June 2012 in Jeddah, Kingdom of Saudi Arabia. We describe an unusual case of a 42 year old healthcare worker who was admitted to our Intensive Care Uni...

A 28-year-old man was admitted due to progressive headache and blurred vision. Neurologic examination showed bilateral papilledema. Brain MRI showed a cystic posterior fossa tumor compressing the fourth ventricle with tonsillar herniation and cervical syringohydromyelia (figure 1). The tumor was removed through a suboccipital craniectomy and pilocytic astrocytoma was diagnosed histologically. O...

Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning h...

Chiari malformation is a congenital anomaly that primarily involves the downward displacement of the cerebellar tonsils through the foramen magnum and elongation of forth ventricle and lower brainstem. Patients with Chiari I (congenital or acquired) malformation are asymptomatic or may present with neurologic signs and symptoms. It is always a question of safety of neuraxial anesthesia in these...

PRESENTATION A 76-year-old woman, complaining of leg pain and unsteady gait for 3 years, presented with a spastic paraparetic gait, severe spasticity and touch, thermal and pain sensory loss limited to arms, lower thorax and upper abdomen. Brain and spinal cord magnetic resonance imaging showed a large loculated syrinx. Cerebellar tonsillar herniation into the foramen magnum was also seen (Arno...

In a recent issue of Critical Care, Wu and Orizaola Balaguer [1] hypothesized that nociceptive head turning after brain death (BD) is a spinal reflex. We argue that it can be a supraspinal response, which would invalidate a diagnosis of BD. The sternocleidomastoid and trapezius are innervated by the spinal nucleus of the accessory nerve extending from the lower medulla to the ventral horn of th...

Water intoxication causes hyponatraemia, which is responsible for the neurological dysfunction by causing intracellular overhydration. Symptoms may occur if the serum sodium concentration is less than 120 mmol/l, but the degree of brain dysfunction corresponds with the rapidity of development of the hyponatraemia. Intracellular potassium concentration is reduced, partly due to increased intrace...

We present an unusual case of recurrent cough syncope in a 43-year-old woman, which was initially thought to be seizures. Syncopal episodes were triggered by paroxysms of cough and were characterized by unresponsiveness and myoclonic jerks in her extremities. She had a left-sided glomus jugulare tumor that extended into the posterior cranial fossa with evidence of worsening communicating hydroc...

SUMMARY Four patients in whom brain deaths was identified on the basis of neurologic and electroencephalographic findings were examined with MR imaging and MR angiography. MR images showed diffuse swelling of the cerebral gyri and cerebellar cortex, which prolongation of both the T1 and T2 signal (representing hypoxic ischemic brain injury), downward displacement of the diencephalon and the bra...